Osteochondral autograft transplantation offers better outcomes than microfracture treatment for medium-sized talar osteochondral lesions, according to new research.
Size Matters When Treating Talar Osteochondral Lesions
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Secondary#microfracturetreatment#osteochrondralautografttransplantation#talarosteochondrallesion
Previous research has shown that microfracture treatment or arthroscopic marrow stimulation is less successful when it comes to larger talar osteochondral lesions, specifically those larger than 150mm. There has been little data, however, on if one treatment is superior to other for medium lesions.
In this newest study, “A Comparison of Functional and Radiographic Outcomes following Microfracture with Extracellular Matrix Augmentation versus Osteochondral Autograft Transplantation for the Treatment of Medium-Sized Osteochondral Lesions of the Talus,” Hospital for Special Surgery (HSS) conducted a retrospective study comparing the clinical outcomes after treatment of medium-sized talar osteochondral lesions with microfracture treatment using extracellular matrix and bone marrow aspirate versus osteochondral autograft transplantation.
Twenty-seven patients were treated with microfracture and 33 with autograft transplantation for a talar osteochondral lesion between 80 and 165mm. The procedures were performed between 2015 and 2018. There was a minimum of 12 months of follow-up.
Clinical outcome measures included patient-reported functional outcomes and the Magnetic Resonance Observation of Cartilage Repair Tissue or MOCART score.
Overall, the osteochondral autograft transplantation group had higher MOCART scores (71 vs. 55.6; p = 0.04) suggesting that a single osteochondral autograft plug may be superior when it comes to structural repair. Functional outcomes in this group were also higher. These patients also reported less pain and depression and had higher global mental health scores (61.71 vs. 51.90).
“The key takeaways from this research are the open procedure more closely replicates the normal anatomy than the arthroscopic procedure—they are not equal,” said Mark C. Drakos, M.D., HSS foot and ankle surgeon and senior study author. “The findings validate the need to perform additional research to ensure the less invasive arthroscopic procedure has better outcomes similar to those of the open procedure.”
The study was presented as a part of the AAOS 2020 Virtual Education Experience.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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